9901-123 (SFD)�t LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # .. Lia Class Exp. Date
4786f39 13 "l0
t/D at e, "` ' r Signature of ContYactor•���( -
OWNER -BUILDER DECLARATION
I hereby.affirm under penalty of perjurythat I am exempt from the Contractor's
License Law for the following reason-'-.
1,.as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
'sale (Sec. 7044, Business & Professionals Code).
1,"as .owner, of the property, am exclusively contracting with licensed
contractors to constructAhe project (Sec: 7044, Business & Professionals
Code): •�. � ° • .
O I.am exempt' under Section B&P.C. for this reason
Date ',.Signature of Owner
WORKER'S. COMPENSATION DECLARATION
I. hereby affirm under penalty of perjury one of. -the following declarations:
s ,(<)'I have and will maintain a certificate of consent to self -insure for workers' .
compensation, as provided for by Section 3700 of the Labor Code,.for the
performance of the work for which this permit is issued.
Se( ) I' have and will maintain workers' compensation insurance, as required by
ctiori 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. Iare:
carrier Policy No.
�t?ttsAiNWC.34770J.400
(This section need not be completed if the permit valuation is for $100.00 or less).
(. ). I certify that in the performance of the work for which this permit is issued, '
I shall not employ.any person in any manner so as to become subject to the
workers' compensation laws of California, and.agree that if I should become
subject to the workers' compensation. provisions of Section 3700 of the Labor
Code,> shall forth -Wit h comply with those provisions.
Date:" •' Applicant -----.i
Warning: Failureto secure Workers' Compensation coverage is unlawful and
'shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of.the Labor Code, interest and attorney's fees..
IMPORTANT Application is hereby made to the Director of Building and Safety
for. a permit subject' to the conditions and restrictions set forth on, his
Application. .
1. Each person upon whose behalf this application is made & each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued.as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quints, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work, is not commenced within. 180 days from date of issuance of such
permit, or cessation of work for 180'days will subject permit to cancellation.
I certify.that'l have read this application and state that the above information. is
correct. I agree to complyWith.all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
.. r «
Signature. (Owner/Agent] •»- ''W`°'`'`-"°'""" " Dater
BUILDING PERMIT PERMITN'
DATE VALUATIONLOT I TRACT �s77�
$'2.39,171.00
' . q
JOB SITEAPN
_
ADDRESS /3- 8 SO T11IERN fffl"
'769.81.0-001.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SOUMERIN BILLS, LLC
KC. HOBBS d% SIDUi"I-IERN BILLS, LLC
7.4N) E CHAPMAN AVE_., Ste 100
35-960 PGA BLVD
ORANGE CA 93886
LA QUINTA CA 92253
(I14)MM60 CBL# 5487
USE OF PERMIT
SING 1.E RA ILY 1AV.>'1;LNIG
LOT 8, PLAN WR -SF D- P0I 41T Db1rS NOT INCLUDE BLC)cM WADS OR
POOLS, .PI,AN C'fW K FU REDUCED 95% FOR MULTIPLE ISSUANCE OF
SANX PLAN! YPE.
CUSTOA4 CONSTKUCT ION 2,780A0 SF
P(DItC YPATIO 330.00 SF
GARACE'CAR!'ORT 930.00 W.
ESTIMATE,) COST Or, CONSTRtfCIION
2•:'19,179.1111
PERMIT FEE SUMMARY
CONSTRUCTION 1: EE 101-000-418-000
PLAN CHEM FEE 101-000-439-M $230.96
MEC1iANICAL fW.. 10.1-000-421A00 $105.00
HLECT RICAL FEE. 101=000 120.000 S173.40
PLUMB LNG f,U"W 101-000-410-000 51:16.50
STRONU'MOTIG FEE -RE,S.O t01-000.241-0110 823.3.
t ,'yD= 101--000-423.000 $2ti.M►
INFRA:."PRUC'TURE'F.EIE 225.000-4=13-3,42 55,282.713
AfUr IN PLIBI.,IC P.LACr—% <'Ri.S',It •701-01)0-255-000 :5347.95
SUB-TOT—AL CONMUCTION A:ND PLAN CHECK
$7,50.01
1,. SS PRE -PAID RIES
0.00
TOTAL PEMUT FEES DUE NOW,
57,500,01
RECEIPT
DAT
D�E
BY� ` '/°
�y/
DATE FINALED
INSPECTOR
J r
f.
1 f
if
✓ ;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation ooVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 2
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 3 s 9
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
j
Oct -29-99 09:50A
P -Ol
4`.
The DanDee
Con y bW- I is 732542
ROOF/NG AND CONSTRUCHON
Roofing Proposal
P. 0. Box 277 T110m,11mif Palms; CA .92276
Phone (760) 343-3385 Fax (760) 343-3096
BIDS TO: JOB NAME:
THE R,C. HOBBS COMPANY MONTECITO COLLECTION
55-960 PGA BLVD. PHASE# 1,
LA QUINTA, CA 92253 LA QUINTA, CA 92253
PHONE# 564-1551 FAX# 564-5091' DATE 10-28-99
THE DAN DEE COMPANY INC. HAS SUPPLIED, AND INSTALLED
THE FOLLOWING AMOUNT OF O-HAGIN ROOF VENTS.
-LOT# _ 9 OF VENTS
1
1s
2
17
3
16
4
17
6
1s
6
17
7
16
9
1s
----------
NOTICE
Under the Mechanics' Ltert I.aw ICatifomia Cale or Civil Pro aerture Section 1161 el Se.tl ). any convan-rr, snbcanrracior. laborer. supplier other person no hPlpi to
trnptove your prr,perty but is not paid for his walrk nr Rupplies, has a right to enforce a daim
against your property. This moans that, ane( a court hearing your property
rould he sold by a court officer ann me proceeds of the sate used to sansly, the indebtedness. This can happ9n evan d you have paid your own conhautuf to full If rrte
Subwntractor, larwer or•supplier remains unpaid and ii legal action is neoeabwy to collect or enfnrre The terms of this contract. the pievatdng piny Shall IAF r mitt d to its
reasnnaae attomey fees pi" all cO51t1 of suit and interest shall accrue an all RUMS, v,hich are true 30 days after billing at the rate at id /per annum. The DanDee Co.
Inc. is not resWnsve for delays caused by wuather. strike, material shortage or delay in malenal gttprd*d to the jou or to any other delay buyotid its contrr+l Tri:
DanDee Co Inc, total liability unner tis contract or in negligence is Itrnned solely to the amount of this tontrrq
We are fully Covered by wQrftmen's compensation and,pubfic liability insurance. Carriers names and ooiicy numbers available on
reques,L
tiny alteration or deviation num the a above- specifications involving extra cost of material or labor will only be executed upon vwittun urders tot' sera?, a w will biome
an extra diarye over the sum mantinned in this proposal. All agreements must he made in writhing and is basud ort free acvess Io building fnr direct loading from vut
rrut?,5.
Prices are based on current costs of material and labor. Increases or decrease& udll ho nufietxed at time of Signing contract.
Before and or during roofing operations and the completion of roofing, The DanDee Co Inc, will not be respunsible or liable for damage caused from
acts of God. Stich as eaethqualtes, thunderstorms, hatl or any other weather conditions beyond roofers control.
DATE
(i DATF
TII1f i)nNDlit: CO PROPOSAL VALID FOR 3-6 PAYS -
■ AMR
�� to or
upancy
■
_
City—of-Lia.
tsuildin and .S f
- _ ety Department �oFr�
This Certificate issued pursuant to- the requirements of Section 109 .of the Uniform Building Code,
certifying that,, at the time of issuance, this structure was in compliance with • the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 54-548 SOUTHERN HILLS
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: SOUTHERN HILLS,. LLC
VN
Bldg. Permit No.: 9901-123
Land Use Zone: RL
Address: 1430 E CHAPMAN AVE, STE 100
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
Date: 12/29/99
Building Official
POST IN A CONSPICUOUS PLACE